- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $18.20 / $91.20 / $169.82
| Facility | | $18.20 | $91.20 | $169.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $8.91 / $12.88 / $26.92
| Professional | | $8.91 | $12.88 | $26.92 |
- Facility/Professional
- Professional
- Modifier
- CO
- Typical Low / Median / Typical High
- $17.38 / $17.38 / $17.38
| Professional | CO | $17.38 | $17.38 | $17.38 |
- Facility/Professional
- Professional
- Modifier
- CQ
- Typical Low / Median / Typical High
- $16.22 / $32.36 / $32.36
| Professional | CQ | $16.22 | $32.36 | $32.36 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $12.88 / $17.38 / $19.05
| Facility | | $12.88 | $17.38 | $19.05 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $12.88 / $16.98 / $20.89
| Professional | | $12.88 | $16.98 | $20.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $12.02 / $15.14 / $15.49
| Professional | | $12.02 | $15.14 | $15.49 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $11.22 / $19.95 / $72.44
| Facility | | $11.22 | $19.95 | $72.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $13.49 / $16.60 / $47.86
| Professional | | $13.49 | $16.60 | $47.86 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $16.98 / $18.20 / $25.12
| Professional | | $16.98 | $18.20 | $25.12 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $16.98 / $20.89 / $42.66
| Professional | | $16.98 | $20.89 | $42.66 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $16.98 / $22.91 / $31.62
| Professional | | $16.98 | $22.91 | $31.62 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $16.60 / $16.60 / $16.60
| Facility | | $16.60 | $16.60 | $16.60 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $12.88 / $16.60 / $39.81
| Professional | | $12.88 | $16.60 | $39.81 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $18.20 / $19.95 / $23.44
| Professional | | $18.20 | $19.95 | $23.44 |